POS1480 DESCRIBING RENAL FUNCTION TEST USE IN REAL-WORLD DIAGNOSIS AND MONITORING OF LUPUS NEPHRITIS PATIENTS IN EUROPE
Authors: B. Asin, A. Eberhardt, A. Fernandes, D. Clamp, E. Goddard
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lupus nephritis (LN) is a severe renal manifestation of the autoimmune disease lupus. Tests for renal function, such as estimated glomerular filtration rate (eGFR), should be standard in the diagnosis and monitoring of patients with renal disease as recommended by the Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease (CKD) Working Group <sup>[1]</sup>. These tests are important to identify renal function decline and prompt interventions to prevent further disease progression. It has been found that use of eGFR is low in Italy for CKD patients <sup>[2]</sup> but data on real-world testing in other countries is limited. <h3>Objectives</h3> To understand renal function test use by nephrologists in the diagnosis and monitoring of LN patients in Europe in a real-world clinical setting. <h3>Methods</h3> Data were sourced from the Adelphi Lupus IV Disease Specific Programme™, a point-in-time survey of nephrologists and their LN patients conducted in France, Germany, Italy, Spain and the United Kingdom in April – October 2021. Nephrologists completed patient record forms covering each patient's management, including tests and assessments used for diagnosis and monitoring. The data was analysed descriptively. <h3>Results</h3> 72 nephrologists provided data for 376 LN patients. Overall, 20% of LN patients in the sample did not have a Glomerular Filtration Rate (GFR) or eGFR test documented to diagnose their condition. The use of these tests at diagnosis was lower in Germany and Italy (≤72%) compared to the other countries where use was over 80%. Of all the patients without GFR/eGFR at diagnosis, only 43% had an alternative renal test completed (e.g. urine protein, creatinine clearance (CrCl), albumin-to-creatinine ratio (ACR) or 'other urinalysis test' (including urine protein creatinine ratio)). Across Europe, the use of GFR/eGFR to monitor patients with LN was 85% or above, apart from Italy where 31% of patients did not have either test. In patients without GFR/eGFR for monitoring, the use of alternative renal tests was higher than at diagnosis (60% vs. 43%). However, 40% of those patients received no other renal test (e.g. urine protein, CrCl or ACR) to monitor their condition. <h3>Conclusion</h3> GFR/eGFR are key markers of renal function as discussed in the KDIGO recommendations <sup>[1]</sup>, but this analysis observed lower-than-expected use of GFR/eGFR among nephrologists. This was especially apparent in Germany and Italy. There may be even less use of these tests among non-nephrology specialities. Lower-than-expected use of these recommended tests indicates a need for improvement in the diagnosis and monitoring of LN patients in Europe. This suboptimal management may be affecting patient outcomes, but further research is needed to assess this. Results are subject to recall bias which was minimised by asking survey respondents to use patient medical records for the completion of forms. <h3>References</h3> [1]Levin A et al., <i>Kidney Int Suppl</i>, 2013, 3(1):1-150 [2]Pesce et al., <i>J. Nephrol</i>, 2022, doi: 10.1007/s40620-022-01353-6 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Beatriz Asin Employee of: UCB, Alexion Pharma UK Ltd, Concordia Healthcare Corp., Advanz Pharma, Otsuka, Alice Eberhardt Shareholder of: AbbVie, Employee of: Mundipharma, Allergan, AbbVie, Otsuka, Ancilla Fernandes Employee of: Otsuka, David Clamp Employee of: Otsuka, AbbVie, Allergan, Emily Goddard: None declared.